Episode 17: Top 5 Questions
Episode Summary
In this episode, I'm answering five of the most common questions I get about fat positive fertility. These questions originally came from a video I recorded for my Ko-Fi Community but they were too good not to share here!
Whether you're curious about navigating fertility in a bigger body, looking for evidence-based insights, or just need some reassurance, this episode is for you. And if you have your own questions, come join us in the Ko-Fi Community, where you can ask me directly!
The questions:
Can I really get pregnant in a bigger body?
What do I do if my doctor denies me fertility care based on my BMI?
Can I access fertility treatment in a bigger body if I need it?
Will losing weight make it easier to get pregnant?
Is it safe to get pregnant in a bigger body?
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Top 5 questions for podcast
Hey my lovely. Welcome to Fat and Fertile, the podcast. I'm Nicola salmon. Pronouns. She and her. I'm an award winning fertility advocate and fat positive fertility specialist, and I am so passionate about supporting fat folks who feel excluded or dismissed by traditional fertility spaces. On this podcast, we'll tackle weight bias within the fertility industry. We're going to explore how to navigate your fertility journey without diets, shame, or stigma, and empower you to trust your body and take control of your reproductive health. If you're looking for more support, be sure to download my free Fat Person's Guide to Getting Pregnant. Or join my Kofi community. It's a space for fat folks to connect, share, and find compassionate support. You'll find all the links in the show notes. I'm so glad that you're here. I'm in your corner and we've got this together. Hey, loves. Welcome to today's podcast episode. In today's episode, I'm going to be sharing five questions that I often get asked about fat positive fertility. This is from a video that I recorded for my coffee community a couple of weeks ago. So Nicola is going to fill you in on the answers to these top five questions. They were too good not to share on the podcast, so I hope that they are helpful. And if you have questions that you want answering, come over to the coffee community where you can ask me personally all of the questions that you have around getting pregnant in a bigger body. So let's get into the questions. I've picked five that I hear really commonly. Um, and I'm just going to share a little bit of my kind of like top thoughts. If there's anything that you're like, oh, I want you to talk more about that. Tell me in the comments. Tell me what you're thinking. Tell me what you're feeling. Um, and I absolutely can do that in another one of our Q&A audios that will come every month. So the first question, the biggie, the one I get most of all, is can I really get pregnant in a bigger body? We are so conditioned to believe that fat people don't get pregnant, fat people can't get pregnant, and I just want to start out with like I am living proof that that is not true. I can stand here 100% and say that fat people do get pregnant, um, without intervention, without, you know, any issues easily because that was my story and that was my circumstance. Um, I got pregnant twice in a bigger body without intervention. Um, had completely boring and ordinary pregnancies with both my boys. So I just want to give you a resounding yes. It is absolutely possible for folks in bigger bodies to get pregnant without it being a problem, without there being any concern. Even though we've been conditioned otherwise. So I want you to let that sink in like it is totally possible if you are at the start of this journey, if you haven't been trying it or you've not been trying for very long, it is totally possible that this is going to be easy for you. Now we know that fertility is influenced by so many factors. It's influenced by age, it's influenced by our environment. It's influenced by like our stress levels. It's influenced by our hormone levels, our genetics, our access to healthcare. There are so many things that impact our health and our fertility, and only a small amount of that is within our control. So, you know, like things like your genetics, things like your environment, the the city you're born into, your access to clean water to different foods, all of that is like mainly out of our control and even things like movement and the foods that we eat and our sleep and our stress levels. All of those like what they call like lifestyle factors. Um, so much of that isn't within our control either. Like we are born into different cultures where we have different diets and different foods that are traditionally served, and so much of that is impacted in different ways. So I just want to let you know that there's so much of this that is not within your control and so much of it, while it feels like it's the thing like if you search fertility diet on Google, you'll get millions and millions of hits and you can some like assume from that that food and diet is the biggest thing that influence your influences, your fertility. But that is just not true. Um, but the most important thing that you can do, if you're at the point where it's been more than a few months and you're worried, is to surround yourself with a supportive healthcare team. Find someone that's going to be on your side, that's rooting for you, that wants this for you, and then you can start building up a picture with data, with things like blood tests and scans and all of that stuff that can go with it. And if you're worried that it's not happening fast enough, but. You do not feel need to feel ashamed. You do not need to feel that you have done something wrong. If you want to get pregnant in a bigger body. You are absolutely so worthy of getting pregnant in a bigger body without making your body smaller. So I hope that has been helpful to the question can I get pregnant in a bigger body? The short answer is yes. And really, you absolutely deserve to do that. If that is your life choice, then next question that I really commonly get is what do I do if my doctor denies me fertility care based on my BMI? I wish this wasn't a common question. I wish this was something that very rarely happened, but unfortunately that is not the case. This happens quite a lot. Whether that is you're you're seeing your GP or your primary care physician. Um, and you're asking for like some basic tests and treatments. Sometimes they can just say, oh, just go away and lose some weight, and then that will help and fix it, the magic cure and come back then. Um, and it can also happen when you go and see specialists like, uh, fertility doctors or reproductive anthropologists, IVF clinics, all of those things. It can happen where your doctor is firmly rooted in the idea that BMI impacts fertility. So the first thing that I would always recommend is trying to find someone who practices weight neutral, inclusive, non-discriminatory care and supports people of all sizes. Now I have a list on my website of fertility clinics. If that is something that you're seeking out specifically for support, it's a list that I've collated over time of different people's recommendations. So whilst they can't guarantee that it's up to date or that people have changed their beliefs or change their practices, it's a really great starting point. Um, for some clinics and some places that you might want to go first to see if you can get the care that you need. Um, some places, the other places that you can go is if you have local Facebook groups that are dedicated to like, uh, fat activism or fat meet ups. There's quite a lot at the moment, um, that I'm loving around kind of fat people outside, like we have like, um, I think it's called Everybody Outdoors, which is this really amazing, um, group of people who are advocating and supporting people going hiking and walking and climbing and kayaking and all of this good stuff outside, like no matter how adjacent it is, if it is related to the fat experience, there may be people in there who've had experiences within your area if it's local to you, um, with different care, different doctors, different health care professionals. So no matter who you're looking for, that could be a really good way to find some recommendations, because those first hand recommendations are always going to be the gold, right? Finding somebody who's had an experience, who's also in a bigger body is a great way to kind of shortcut this and find those good clinicians who are going to support you. It's also really important to understand that you absolutely deserve that care. You absolutely deserve to be supported without judgment, without shame, without jumping through hoops in order to access treatment. Um, and that is your basic human right. Like in the I'm not going to post it and I'm not going to quote it word for word. But, you know, with the World Health Organization, the W.H.O., like they have this reproductive right, which is everybody should have access to be able to decide and determine when they have their children and get support through that. There's no BMI requirements for that, right? That you should have that, uh, ability to seek that support. Um, and also if you don't feel, um, confident or you've never practiced and been taught how to advocate for yourself, working with somebody who has experience and confidence in that can also be really helpful. So, um, I advocate on behalf of people that I work with. I know there are some great fat, positive other fertility professionals out there. Um, some like therapists, nutritionists, Nutritionist, dietitians. All of these kind of adjacent healthcare professionals. If you find someone who is fat positive, who is anti diet, who is weight neutral, they can be really great advocates on your behalf too. So you do not have to do all this, this work alone. Um, and if you're part of the Kofi membership, that is a course that you can access, which is about advocating and building up those skills. So absolutely get on that. If that's something that you need to build up, because it's not something that we are ever taught in school, especially people conditioned as women, we are never taught how to advocate for our rights, for our needs, for um, yeah, our basic humanness. So don't feel bad that you don't know how to advocate for yourself. Don't feel that you are somehow less than or stupid for not understanding that we are intentionally not taught that right? Um, but it's something you can absolutely learn and with practice that you can get better and better at. So. Absolutely recommend that, um, that's something that you could build up as part of your skill set. I just don't know why I did not advocate for myself until I was 29. That was the very first time that I understood. Um. I could even question a doctor. So please don't feel like this is something that you should have known earlier. Like we are all coming to this when we come to it because this information is intentionally kept away from us. So that is the second question. What do I do if my fertility doctor denies me fertility care based on my BMI? So I would say seek out a great fertility provider if you can believe that you are worthy of accessing that care and finding people to advocate with you is a great way to do it. Okay, the next question that I often get asked is, can I access fertility treatment in a bigger body if I need it? And this is a really great question. So I live in the UK and we have something amazing called the NHS, which is the National Health Service. And in theory, you are supposed to be able to get free access to healthcare at the point of service. So when you go and see your doctor, when you go to the accident and emergency department, you're supposed to be able to access free healthcare, which is wonderful and incredible. But the service, unfortunately, through poor government, has been declining and being cut and money has been taken out and we are at a point with it now where it is really difficult to access fertility care for anybody, um, especially if you have a higher BMI. So. People often think and often come to me, especially if they're in the UK, to think that they cannot access fertility treatment because they have been told that their BMI is too high and that nobody will treat them. And I just want to say that is not true. Whilst in some places it is harder to find fertility clinics, there are fertility clinics all over the world that do not discriminate based on weight and that actually understand that people of all BMIs can and get pregnant and can have totally safe and ordinary pregnancies. So your BMI does not exclude you from accessing fertility treatment if that's something that you need. It can be a bit trickier to find them. And that's where the list on my website can be really helpful. It can be sometimes tricky to navigate, like sometimes clinics will have that available, but maybe they don't understand how to talk to patients and they might still recommend weight loss, or they might still judge you or shame you. So it's not an ideal world where every clinic is fat positive and is, you know, totally understands what weight stigma is and know how to treat people. I wish that were the case, and it's not. But there are clinics out there who are that are good. There are clinics out there that exist that do support people in a really patient centred way and really understand that fat boats are fat folks absolutely deserve to access this treatment, and we'll do it with compassion and kindness. They may be a little bit harder to find, but I promise you that they do exist and you absolutely deserve to have that type of care if it is available. Like in terms of location or financial privilege, like obviously there are so many other factors when it comes to treatment. They can be really expensive. They can be really far away. But you know, you do. You do deserve to access that care in a in a really compassionate way. So my answer to that question, if you can access fertility treatment, if you need it, it's 100%. Absolutely. But it depends on where you live and so many other factors as to how easy that is to access and find. But definitely check out my clinic list if that's something that you're doing right now. And also, you know, like every month in the group, I'm going to pop a little post in there so that if you are actively searching for a clinic or a healthcare provider, you can just pop in where you are, what you're looking for, and I'm happy to do a little bit of research to see if I can find you some pointers to lead you in the right direction. So that's one thing I can definitely do. The next question so I think this is question four, is will losing weight make it easier to get pregnant. And I so understand where this question comes from because. Nearly every fertility clinic or doctor that you know, I hear stories about will say, we'll talk about this magic 5 to 10% rule, which goes something like, if you just lost 5 to 10% of your body weight, then you'll get pregnant easily. And it's just a it makes me want to kind of throw my head against a brick wall repeatedly, because it's just so simplistic and it's just so wrong. It's been disproved time and time again, and this magic number comes out. Whatever you're talking about, whether you're talking about fertility or cardiac issues or diabetes, you know, anything where they are linking weight to this particular healthcare condition, they'll bring out this magic number. And what's interesting, when you start to kind of deconstruct the logic behind it, is that they're saying, well, for somebody who is at say, they're at a higher weight here, if they were to bring their weight down to this little bit. Yeah, somebody who's already down here and they bring their weight down a little bit here, those people are both going to be in the same situation of losing their 5 to 10% of body weight, even though they're then saying, well, this person is still, um, whatever technical words they'll use. You know, the old words, um, it makes no sense. So what is actually happening is that we know that the research is not conclusive around this at all. In fact, there have been some really good studies over the last couple of years that have shown specifically with high groups of people, that losing weight doesn't have an impact on fertility. And again, if you want them, let me know in the comments. And I am so happy to share them because these are really good, like boom doctors, this is what you don't know what you're talking about. Like they are really good like and also for yourself. Like when I talk about research, I say it's great to have to share with your doctors and health care providers if that feels helpful and safe to do so. But if you've got like a research minded brain, it can also be really useful to do for yourself, right? Because sometimes we can doubt our own capacity, our own capability, and we understandably believe the years of conditioning, which has said that we can't get pregnant in a bigger body. So this research can be really useful for our own brains of going, yes, brain, look at this. This is exactly what it shows. So totally not conclusive. Great studies out there that show it's no impact of weight loss. And even the ones that do show this correlation. So not causation. They've never shown that there is a causative effect going on here. So as in that the weight increase causes any issues with fertility. Um, it's just a correlation means that as one goes up, the other goes up. They've shown they've never separated out the impact of the behaviour change which so many people do, such as increased movement, change in diet, increased hydration. You know, all of the things that can happen when you're focused on a health intervention and the weight loss, right. Like those are two things that we can measure separately to see what the impact of those is. And actually what we found is in studies where people increase their health behaviors. So do things like moving more, getting better sleep, improving their stress levels, and they don't see any weight loss. They still show an increase in healthcare marker in health markers such as, um, better blood pressure, better blood sugar levels. Like all of the things that biologically we know impact health, that we can measure, we see a benefit in those even when the weight doesn't change. So it makes so much sense to me that what we're seeing with that magic 5 to 10% rule. Going back to that, we're seeing that change in health markers, right. Like we're seeing people changing those health, um, those health behaviors. And is that that is changing it because it doesn't matter what your weight was. They're saying there's this magic 5 to 10%. So we don't want to focus on the weight at all. But we want to do is focus on those health promoting behaviors, if that feels good to do so, because above all else, it's your body and you get to choose what happens to it. Um, and also, like you don't need to perform health in order to be worthy of accessing fertility care. I want to make that abundantly clear. Like we talk about health promoting behaviors, you do not need to do any of that in order to be worthy of accessing fertility support. It is your body and your choice. So yeah. So losing weight will not make it biologically easier to get pregnant. Increasing health behaviors may also. What is reduced when you lose weight is weight stigma. So weight stigma is the impact of people's perceptions of you. So for example if the doctor is weight stigma chances they are and you might get a smaller, shorter appointment time, you might get fewer tests and treatments. You might be told that you're you know, that it's your fault or your fault. You can't do this and you can't get pregnant. And you know all of that shame talk. So all of these things are impacts of weight stigma, right? Like the way that they see your body and fat people in general changes how they treat you and changes the healthcare that you get changes so many different things. And this has an impact on how easy it is for you to get pregnant. If you are told that you'll never be able to get pregnant by your doctor and made to feel shit if you don't get access to fertility tests and treatments. If you are just sent away and told to lose weight and never supported through this process, all of these things can make it harder to get pregnant. So the one thing that weight loss can offer is a reduction in that weight stigma. So they'll help you more. And it means you. It may mean that you can get more access to to fertility treatment. So if you're hovering around a BMI limit for a fertility treatment clinic, for example, it may mean that you can then access that fertility treatment if you lost weight. That is the only way that making the losing weight will make it easier for you to get pregnant. And it's abhorrent to me that. We have a healthcare system where we where we. We have this that it exists and that you have to jump through these hurdles and these barriers to be able to access the care that you need. And it's not based on your biology. It's based on the perception, the biases of the healthcare professionals. So I hope that makes sense. I hope I've explained that well, because it's really important to understand that your body is just doing its thing, right. But because of the people around us and the way that we are treated, that can have a really negative impact on on our belief in our bodies and also our body's capacity for getting pregnant. And then the final question that I think it's really important to acknowledge and answer is, is it safe to get pregnant in a bigger body? Because I know so many people that put it off because they are worried. They are worried. They don't want to be a bad parent before they've even started. They are worried about the things that we're told will go wrong. They are worried about all the different perceptions out there in terms of what will go wrong. Like we're told that these are certainties, that things are going to go wrong in our pregnancies. And first of all. With the right care and support, you can absolutely have a healthy pregnancy in a bigger body. Sure, there are things that you might need to be aware of, such as? Like in the research, we tend to have lower levels of folic acid, so that's a good one to supplement and you might need a little bit extra. Um, but for people who understand how to take care of folks in bigger bodies, the right care and support your your pregnancy will be just the same as somebody in a smaller body. There are little things that we might need differently, but absolutely that care should be personalized to you. It is not. We are not a monolith. Not all fat people need x, y, z. Like in the same way that not all people need x, y, z. Um, and there are increased likelihoods sometimes, like some research has shown that fat folks have increased likelihood of certain conditions like gestational diabetes, um, pre-eclampsia, um, miscarriage. But again, these are not clear cuts. So the research is not black and white. It's not the fact that all this research shows this is really muddied. Some does some doesn't, some does. But it's not statistically significant. It is muddy water. And the fact is that none of these take into account the weight stigma that I mentioned previously. So we don't know if it is the fact that these people are under so much stress because their doctor is saying, oh, you know, these things are going to happen, you're definitely going to get these conditions. And then of course, that increases their stress levels, that increase their allostatic load, their cortisol levels, their adrenaline levels, like of course, that has a real impact, a real physiological impact on your body. Um. So by making sure that you're surrounding yourself with people who care for you, who treat you well through your pregnancy, who support you through that process that is going to reduce that stress, is going to make sure that you feel taken care of and looked after, which, again, will reduce those potential risks, because I think so many of those increased risks are due to, um, that stress that we're put under from being a bigger patient. Um, and when they talk about these likelihoods, they often mention really scary things like, um, let me try. And it's been a while since I've quoted these stats, so let me see if I can remember what they are. So I think it's for gestational diabetes that they talk about like oh, you're five times more likely to get it. Which sounds terrifying, right? Like that sounds really scary. Like oh my gosh. Like that sounds like I'm definitely gonna get gestational diabetes. But actually I think and I'm going to forget the numbers now. I think it's like 2% of folks in what they call quote unquote normal bodies, um, get gestational diabetes. And then five times that is ten, right? So these are rough numbers. So 10% of folks in higher weight bodies may experience additional gestational diabetes, but that means 90% of folks in the highest weight BMI category don't get it, which I think is a much better stat to go with, right? Like instead of saying you're five times more likely to get it, you could say, oh, 90% of people who have your BMI don't get gestational diabetes. That lands very differently and is still true based on exactly the same stats. So how we talk about this stuff is also really important. But ultimately, I think with the right care and support, it is absolutely safe to get pregnant in a bigger body. And also, it's really important to recognize that some people will get these conditions through pregnancy and it's not your fault you have not done anything wrong. It just happens. And with the best care and with the right support, you will absolutely gonna sail through that. Gestational diabetes happens to so many people in all size bodies. You just need to take care of yourself through it. Like, we have really competent care teams that help people through that every single day. It doesn't need to be something that's scary or something that should be. You should be made to fear. So that was a whistle stop tour. Through those five questions. I really hope that's been helpful. I have so enjoyed sharing some tidbits and different things that I really commonly get asked about, and I would love your questions. So as part of the coffee membership, if you would like to come and join us over there in the community, you get to ask me all your questions every single month. You can pop them in, um, a regular Q&A box that I'm going to share. You can send me them in a direct message, and every single month you're going to get a bonus podcast episode. So they won't tend to be videos, although sometimes they might be, um, so that you can listen to the answers and you can get your questions answered any time that you need it. It has been such a joy to spend this time with you. I cannot wait to hear what you think. Tell me all your thoughts. Tell me what you thought. Tell me what you took away from it. And yeah, I'll see you next time. Bye. Thank you so much for joining me today on Fat and Fertile. I hope you found encouragement and support as you navigate getting pregnant in a bigger body. If you're looking for more resources. Don't forget to grab your free Fat Person's Guide to Getting Pregnant. And if you'd like to support my work or connect with a loving, kind, fat, positive community, join me over on Kofi as a member, you'll get the chance to ask me anything and I answer all of your questions personally. There's exclusive bonus podcast episodes every month answering some questions. A supportive place to connect with other members who are also navigating the same issues that you are, and access to some of my most loved courses and tools. So whether you're trying to get pregnant or just want to support fat positive fertility advocacy, then we'd love to have you over there. The links to everything are in the show notes. Until next time, take care and remember you are absolutely worthy of all of the support and love that you need in order to grow your family.